A large monitor displaying a map of Asia and a tally of total coronavirus cases, deaths, and recovered, is visible behind Vice President Mike Pence, center, and Health and Human Services Secretary Alex Azar, left, as they tour the Secretary’s Operations Center following a coronavirus task force meeting at the Department of Health and Human Services, Thursday, Feb. 27, 2020, in Washington. (AP Photo/Andrew Harnik)
A couple of days ago, I posted on an editorial in the authoritative New England Journal of Medicine on what we know about novel coronavirus, also known as Covid-19. This was no ordinary editorial, it was as close to an official government statement as you can get. The authors are three of the most respected experts on infectious diseases in the world: Anthony S. Fauci, M.D., who leads the National Institute of Allergy and Infectious Diseases (NIAID). Dr. Fauci has been at the epicenter of every infectious disease outbreak in the US since the AIDS epidemic came on the scene. H. Clifford Lane, M.D., runs the clinical research programs for NIAID. Robert R. Redfield, M.D. is the head of the Centers for Disease Control and Prevention.
The editorial points out that the disease seems to be most prevalent in the elderly and those already ill and that it has yet to be diagnosed in anyone under 15.
The median age of the patients was 59 years, with higher morbidity and mortality among the elderly and among those with coexisting conditions (similar to the situation with influenza); 56% of the patients were male. Of note, there were no cases in children younger than 15 years of age. Either children are less likely to become infected, which would have important epidemiologic implications, or their symptoms were so mild that their infection escaped detection, which has implications for the size of the denominator of total community infections.
The most important takeaway is that Covid-19 is not the bubonic plague and it is certainly not even the 1918 influenza equivalent:
This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.
While the editorial says that a vaccine should begin Phase 1 Clinical Trials in the spring, the close in solution lies in old-school public health activities:
However, given the efficiency of transmission as indicated in the current report, we should be prepared for Covid-19 to gain a foothold throughout the world, including in the United States. Community spread in the United States could require a shift from containment to mitigation strategies such as social distancing in order to reduce transmission. Such strategies could include isolating ill persons (including voluntary isolation at home), school closures, and telecommuting where possible.
Since then, some more information has been released about the nature of Covid-19.
Yesterday, Dr. Fauci, one of the authors of the editorial I cite above, was at a hearing of the Senate Committee on on Health, Education, Labor and Pensions.
Here are some highlights from Dr. Fauci’s remarks.
“If you look at the now 90,000 people who’ve been infected and the number of deaths that have occurred, about 80 percent of individuals who get infected do really quite well without any specific intervention. Namely, they spontaneously recover,” Fauci said in his opening statement.
“However, about 15 to up to 20 percent of individuals – usually those who are elderly and in risk groups wind up getting serious disease requiring supportive care. That could be oxygen. That could be intensive care. That could be intubation or even more dramatic interventions,” he said.
“So we want desperately to have a therapy for these individuals. There are a number of candidate therapies that literally as I speak to you today are being tested in randomized control trials. One of these is called Remdesivir, which was developed by the Gilead company. It is being tested in a large trial in China, and it is also being tested here in the United States in an NIH-sponsored trial in collaboration with Gilead,” he said.
What he’s saying is that unless you are in an at-risk category, for instance, someone who is already seriously ill or who is immune compromised, if you get Covid-19, you’re going to be sick for a short period of time and you’re going to get well.
And there was this exchange between Senators Lamar Alexander and Rand Paul with Dr. Fauci.
“Are children getting the coronoavirus?” Sen. Lamar Alexander (R-Tenn.) asked Fauci at Tuesday’s Senate Subcommittee on Health, Education, Labor and Pensions hearing on the novel coronavirus, also known as COVID-19.
“To a much lesser extent than adults, and for reasons that are still unclear. It may be that they are getting infected, but they’re symptoms are so low they’re not being recognized, but in a number of reports that have come out from China, there are very few cases less than 15 years old. You’ll always find the exception, but most of the cases are a mean age of about 50,” Fauci said.
I suspect that, like with several other viral diseases, that the kids have Covid-19 but they have no symptoms (I have one kid who has this ability with strep throat, she’ll test positive but have zero symptoms). This is a blessing, because children, like the elderly, tend to be more vulnerable to many viral diseases, like flu. On the other hand, it means when grandkids go to visit grandma and grandpa, they might be carrying a very special present.
But let’s put this all into context. To date there have been 128 cases of Covid-19 in the US and nine deaths…as far as I can tell all of the fatalities had other health issues. Now let’s take a look at something much more commonplace, the seasonal flu. Here I’m quoting from the Centers for Disease Control and Prevention’s Weekly U.S. Influenza Surveillance Report.
- Pneumonia and influenza mortality has been low, but 125 influenza-associated deaths in children have been reported so far this season. This number is higher for the same time period than in every season since reporting began in 2004-05, except for the 2009 pandemic.
- CDC estimates that so far this season there have been at least 32 million flu illnesses, 310,000 hospitalizations and 18,000 deaths from flu.
Read the numbers carefully. About ten percent of the US population have had some degree of flu-related illness. 18,000 people have died. And no one cares.
Covid-19 is a public health issue but it is not the issue that the left and the media are making it out to be. Healthy people get well. Children are not affected. The only people at risk are those who are equally at risk for other diseases, like flu. It needs to be monitored and managed. Therapies need to be developed. In short, what needs to be done is being done.
It is a very real disease that is being hyped for political reasons. The people doing it would be ashamed of themselves if they had such ability.